Patients who undergo surgery to remove excess skin less likely to regain weight after bariatric surgery

American Society of Plastic Surgeons (ASPS)
September 30, 2013

Body contouring surgery to remove excess skin improves long-term weight control in patients after gastric bypass surgery, reports a study in the October issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"We demonstrated that patients with body contouring present better long-term weight control after gastric bypass," according to the study by Dr. Ali Modarressi and colleagues of University of Geneva, Switzerland. Since maintaining weight loss to reduce long-term health problems is the key goal of bariatric surgery, the researchers believe that body contouring should be considered reconstructive rather than cosmetic surgery for patients who have achieved massive weight loss.

Better long-term weight control after body contouring

The researchers compared long-term weight outcomes for two groups of patients who underwent gastric bypass surgery. In 98 patients, gastric bypass was followed by body contouring procedures to remove excess fat and skin. A matched group of 102 patients with similar characteristics underwent gastric bypass alone, without body contouring.

Body contouring surgery usually consisted of abdominoplasty (tummy tuck), often with other procedures to remove excess skin from the breasts, legs and upper arms. Within 2 years after gastric bypass, the patients had lost an average of nearly 100 pounds. In subsequent years, patients who underwent body contouring regained less weight - an average of just over 1 pound per year, compared to 4 pounds per year for patients who had gastric bypass only.

Seven years after gastric bypass, patients who underwent body contouring surgery achieved an average weight of 176 pounds, and those with bariatric surgery alone averaged 220 pounds. The average weight before gastric bypass was 275 pounds in both groups. Patients who underwent body contouring had regained about 4% of their initial body weight, compared to 11% for those who had gastric bypass only. After accounting for the weight of excess skin removed, average weight regain was about 14 pounds in patients who had gastric bypass plus body contouring, compared to nearly 50 pounds with gastric bypass only.

Body contouring should be considered an essential part of bariatric surgery

Bariatric surgery produces fast massive weight loss in morbidly obese patients. Unfortunately, many patients regain much of their body weight in the years after gastric bypass, putting them back at increased risk of obesity-related health problems.

A recent study in Plastic and Reconstructive Surgery reported significant improvements in quality of life for patients who underwent body contouring after gastric bypass. The new study shows that patients who have body contouring surgery are also more likely to keep weight off after gastric bypass. Because of this improvement in long-term weight control, bariatric surgery is more likely to be considered an effective procedure, from the standpoint of reducing obesity-related health risks, if followed by body contouring.

Dr. Modarressi and colleagues believe their study adds to the argument that body contouring should be considered an essential part of successful bariatric surgery and, because of its favorable effects on patient health, should be covered by insurance plans. The researchers conclude, "Since plastic surgery after massive weight loss is mandatory for quality of life improvement and weight loss maintenance in many patients, body contouring must be considered a reconstructive surgery for those who have achieved massive weight loss."